Cholera in Mozambique: the importance of WASH and a warning about the future

Themes: Health impact Hygiene Sanitation WASH Water
Countries: Malawi Mozambique

The recent outbreak of cholera in the rural north of Mozambique, after the disease spilled from neighbouring Malawi, has highlighted the vital importance of proper hygiene and access to clean water and safe sanitation to safeguard the population’s health. It is also a sobering warning that rapid population growth, if not met with continuous improvement of services, will leave communities in highly dense urban areas very vulnerable to diarrhoeal diseases, including cholera.

Since cholera spread in Malawi throughout 2022 and early 2023, with around 37,000 cases and more than 1,200 associated deaths – the deadliest outbreak of the disease in the country, according to the World Health Organisation – authorities in Mozambique have been in high alert.

As 2022 drew to a close, the number of cases reported in the Mozambican territory grew, with the first few deaths reported in early January in the Niassa province, which borders Malawi in the north. A few weeks later, the disease had landed in the Tete province, which also borders Malawi, in central Mozambique.

“This outbreak started in rural areas and reached urban neighbourhoods, but in the cities it was controlled”, says Omar Khan, WSUP’s Sanitation Lead in Mozambique, based in Maputo. According to Khan, the main reason why Mozambican cities have been better protected from cholera is simple: improved access to clean water and, to some extent, safe sanitation.

“Most of the large cities in Mozambique have a potable water distribution network in the central part of the city and small water providers in the peri-urban areas, even though cholera persists in some urban areas.” Rural communities in Mozambique have made progress as well in the recent past, “but not in the same level”, says Khan.

The expansion of the distribution network in cities like Beira provides more communities with clean, safe water

Campaigns and new facilities

Whilst better access to clean water makes the difference in favour of urban areas, compared to more vulnerable rural communities, the need for improved systems and services in cities has been increasing, due to the growth in population. “High population density increases the chances of contamination”, explains Khan, who says that, without additional protection over time, “cities will become more and more vulnerable”.

“WSUP was created to respond to this very population pressure in urban areas”, says Khan. “Our work has a long-term vision, preparing the cities for the future.”

Omar Khan, WSUP’s Sanitation Lead in Mozambique, says the cholera outbreak is an alert to urban areas (Photo: Rogerio Simoes)

A future without cholera and other diseases that easily spread in environments without clean water and safe sanitation depends on good infrastructure and effective awareness campaigns. In the Mozambican capital, Maputo, and the coastal city of Beira, WSUP has been working in both fronts.

One good example, says Khan, has been the work done in Beira in 2022, when the focus was in hygiene and sanitation, crucial areas to make sure communities do not consume contaminated water. The actions in Beira included hygiene promotion campaigns and support to SASB (Beira’s Autonomous Sanitation Service) on the construction of new sanitary facilities for very vulnerable low-income families.

“The activists visited the residents of two neighbourhoods, Nhaconjo and Vila Massane. Then we analysed the data and, together with the city authorities and leaders at community level, decided where to build new shared sanitation facilities.” In these projects, WSUP supports the mandated authorities (SASB in Beira and CMM in Maputo) to improve local sanitation services.

João Francisco Guta Sacusi, in front of the toilet he and 15 other relatives used, before receiving an improved new one (Photo: Rogerio Simoes)

In total, 8,654 families were contacted by the campaigners in Nhaconjo, and 2,727 in Vila Massane. Ten addresses where several families lived together, sharing one single toilet in very poor conditions, were then chosen to receive new facilities.

“This kind of improvement, I regard it as a big step forward”, said 69-year-old João Francisco Guta Sacusi, before the beginning of the construction of a new toilet for his household. The old one, in very poor conditions, was shared by a total of 16 people, all members of his extended family, including his nine grandchildren. “I would not have the strength to build a new toilet by myself.”

Shared sanitation facilities like that and regular campaigns have to be maintained and even expanded, says WSUP’s Sanitation Lead in Mozambique, as the needs of urban areas increase and become more complex, with the rapid growth in population. “Urban areas cannot drop their guard”, Khan says. Otherwise, diseases like cholera can once again be a serious threat to those communities.

Top image: hygiene campaign by WSUP agents in Beira, Mozambique.

More about WSUP's work in Mozambique